DHHS Organizational Structure Update
From Kody Kinsley
I am forwarding a letter to you from Secretary Cohen detailing some leadership and structural changes coming to NCDHHS as we build for our future. I have also included text from the letter below for your convenience. In particular, Secretary Cohen has asked that I now take on the role of Chief Deputy Secretary for Health. In this role, I will continue leading our Behavioral Health, IDD, and TBI work, but also take on responsibility for public health, health service regulation, and our ongoing response and recovery work.
These divisions coming together to form my new team gives us an amazing opportunity to bolster our commitment to whole person health. Of course, all this work is made possible by the dedicated public servants we have across all these divisions. I’m particularly grateful for their leadership:
- Division of Mental Health, Developmental Disabilities, and Substance Use Services: Victor Armstrong
- Division of State Operated Health Care Facilities: Karen Burkes, Acting
- Chief Medical Officer for Behavioral Health / IDD: Dr. Carrie Brown
- BH/IDD CFO: Christal Kelly
- State Opioid Coordinator: Elyse Powell
- Public Health: Mark Benton
- State Health Director: Dr. Betsey Tilson
- Health Service Regulation: Mark Payne
As I told my good friends Jean Anderson and Mark Fuhrmann, among others, you won’t be able to get rid of me. Look forward to talking soon.
Letter from Secretary Mandy Cohen:
Dear NCDHHS Partners and Stakeholders:
For more than a year, we have been working in partnership with urgency and purpose to slow the spread of COVID-19, address inequities exacerbated by the pandemic, and work towards recovery.
As with all crises, we have learned important lessons from the events of the past year that we at the Department are acting upon so that we can build on our new way of working together to fulfill our mission and move into a new future together. Below I outline five major changes to our organizational structure that will be in place by July 1, 2021.
1. Health Equity
The pandemic exposed the disproportionate impact of crisis on communities of color resulting from generational impacts of systemic racism and structural disadvantage. It is not accidental that historically marginalized populations were disproportionately impacted by this pandemic, as they are in hurricanes, economic downturns, and other periods of vulnerability.
To continue to embed equity in every aspect of our work, we are creating a new leadership position and recruiting a Chief Health Equity Officer. In addition to leading cross department work on equity, the Chief Health Equity Officer will oversee an expanded Office of Health Equity (formerly the Office of Minority Health) and the Office of Rural Health.
2. Whole-Person Health
The COVID crisis spotlighted how non-medical drivers of health, like the ability to safely quarantine and be able to put food on the table or live in stable non-congregate housing, impact both individual and community health. We saw how vital access to mental health support is for people. And, we saw how fragile food security and emotional well-being is when children cannot go to school for long periods of time and how fragile housing stability is when parents are out of work. The pandemic reinforced the need to accelerate the Department’s work to build a strong, unified health and human services infrastructure that focuses on whole-person health.
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To that end, we are further aligning DHHS divisions and programs. Susan Gale Perry will serve as Chief Deputy Secretary for Opportunity and Well-Being overseeing programs and policies that promote the economic and social well-being of families, children, individuals and communities across North Carolina, including: Divisions of Child Development and Early Education and new Child and Family Well Being, Office of Healthy Opportunities; Divisions supporting Employment Inclusion and Economic Stability led by Deputy Secretary Tara Myers which are Aging and Adult Services, Disability Determination Services, Services for the Blind, Services for the Deaf and Hard of Hearing, Social Services and Vocational Rehabilitation Services as well as the NC Council on Developmental Disabilities and Office of Economic Opportunity. Kody Kinsley will serve as Chief Deputy Secretary for Health, overseeing programs and policies that foster the whole-person health of North Carolinians, including: Divisions of Public Health; Mental Health, Intellectual and Developmental Disabilities, and Substance Use Disorders; Health Service Regulation; State Operated Healthcare Facilities and the new Office of Emergency Preparedness, Response, and Recovery.
3. Children and Families
Children and families often bear the brunt during times of adversity. North Carolina must build on the state's early childhood action plan and work to support children’s healthy development and family well-being across the continuum of their experiences and environments.
We are establishing a new division of Child and Family Well-Being to elevate and coordinate the critical work of supporting our children and families. This division will work to ensure that North Carolina’s children grow up safe, healthy and thriving in nurturing and resilient families and communities. It will bring together complimentary programs from the Divisions of Public Health, Mental Health, and Social Services to maximize services and outcomes for children and their families, including all child nutrition programs (WIC, SNAP and CACFP), the full range of prevention services for children beginning at birth, children’s mental health services, and early intervention programs. We will be recruiting a new leader to oversee this division.
4. Preparedness, Response and Recovery
This past year we have accomplished so much together by breaking out of siloed structures and working together in new ways toward shared goals.
We are establishing an Office of Emergency Preparedness, Response, and Recovery to bring together teams from across the Department to prepare for, respond to, and recover from disasters and health emergencies affecting North Carolina. This new office will strengthen and streamline our coordination and partnership with the Division of Emergency Management at the Department of Public Safety. Our ongoing COVID-19 pandemic response will be led by this office. We will be recruiting a new leader for this office.
5. Transparency and Accountability
Transparent communications and authentic engagement of stakeholders and those impacted by our work is vital to achieving the best outcomes for North Carolinians. Likewise, operational excellence is best achieved by integrating accountability, performance management and quality improvement in all aspects of how we do business.
I am pleased to welcome Dr. Cardra Burns as our new Deputy Secretary for Operational Excellence and Tracy Zimmerman as our new Deputy Secretary for Policy, Strategy and External Engagement.
Dr. Burns is the current Deputy Director in the Division of Public Health and has worked in public health for 18 years in both Georgia and North Carolina. She is currently the Senior Deputy Director for NC DHHS-Division of Public Health. Dr. Burns is also an Associate Professor with Baker College and Ashford University. Dr. Burns holds a Bachelor of Science in Nutrition/Food Science from Georgia Southern University, a Master of Business Administration from Webster University, a Master of Public Administration, and a Doctorate in Business Administration with a specialization in Information Systems Management, both from Walden University. Also, she is a certified lactation counselor. Dr. Burns will oversee Human Resources, Information Technology, Procurement, a new office of Performance Management, Budget and the Controller’s Office, Internal Audit, Property and Construction.
Tracy Zimmerman currently serves as our Senior Director of External Affairs and has led communications throughout the pandemic. Tracy has more than 25 years of experience working on behalf of public interest issues. Prior to joining DHHS, she helped found the North Carolina Early Childhood Foundation and served as its Executive Director. Her public engagement efforts have been nationally recognized, and she has created award-winning public health campaigns. She will oversee policy, legislative affairs, communications, data analytics, and the legal office.
Finally, it is with mixed emotions that I announce that Ben Money will be leaving his role as Deputy Secretary for Health Services in June for a new leadership opportunity with the National Association of Community Health Centers. I am incredibly grateful for Ben’s service to the Department and our mission and goals, particularly throughout this pandemic. His impact on our Department and our health equity work have been profound and he will be greatly missed.
As we move into recovery and building a healthier North Carolina, I look forward to our continued partnership.
Provider Data and Provider Verification Updates
NCTracks Changes to Provider Verification Process
Currently, NCTracks sends notifications for expiring credentials (licenses, certifications and accreditations) to all enrolled providers required to be licensed, certified and/or accredited. These notices are sent to the Provider Message Center Inbox beginning 60 days in advance of the expiration date of the credential.
Effective May 9, 2021, NC Medicaid is taking additional steps to ensure providers meet their contractual obligation and responsibility to keep credentials current on their NCTracks enrollment record by making system modifications to begin a process of 45 and 60 day notifications of suspension if a provider fails to update their credential prior to the expiration date on file with NCTracks. Providers were first informed of this forthcoming system modification in March of 2018.
Choosing from providers with complete and up-to-date licensure, certification and accreditation information allows NC Medicaid beneficiaries to make informed choices to achieve the best health outcomes. System modifications alerting providers to update expiring credentials will assist providers in meeting federal and State enrollment and credentialing requirements and will assist NC Medicaid in removing unlicensed providers and expired credentials from provider records. With updated provider information, NC Medicaid will be able to transmit accurate provider data to health plans and other departmental partners who serve Medicaid beneficiaries.
Provider Data Updates
Providing the most accurate and complete provider information is a top priority so Medicaid and NC Health Choice beneficiaries can make the most informed choice for their health plan and primary care provider. NCTracks is the “system of record” for provider enrollment data, which is then shared with health plans to inform contracting and provider directories.
In our review, the primary challenge with accurate data has been encouraging providers to keep their information accurate and current on all applicable enrollment records. If provider information is not current, then the data that flows forward to the health plans and the enrollment broker will not be accurate.
It is critical that all providers take the time now to review their provider records in NCTracks and submit changes as needed using the Manage Change Request (MCR) process.
Implementation of Rate Floors for Facility-Based Crisis and Mobile Crisis Services
Effective July 1, 2021, NC Medicaid will increase fee-for-service rates and establish rate floors for facility-based crisis and mobile crisis management services that will mandate minimum reimbursement rates to aid in contracting between providers and health plans, including Local Management Entitles/Managed Care Organizations (LME-MCOs) and Prepaid Health Plans (PHPs).
Updating the rates and imposing a rate floor on LME-MCOs and PHPs will help to:
- Stabilize the behavioral health crisis system during the transition to NC Medicaid Managed Care; and
- Support behavioral health crisis providers in the contracting process with PHPs.
The following changes will be effective July 1, 2021:
- Fee schedules for procedure code S9484 will be set at $30 per unit;
- Fee schedules for procedure code H2011 will be set at $90 per unit; and
- LME-MCO and PHP contracts will be updated to include the rate floor.
These new rate floors may create additional capacity and opportunities for enhanced performance by behavioral health crisis service providers, especially those serving geographies that allow for higher utilization of staffing resources. In light of the Department’s commitment to sustainable rates for facility-based crisis and mobile crisis management services, the Department encourages health plans and providers to be innovative in effectively meeting the behavioral health crisis response and de-escalation needs of the communities they serve.
No other changes to the behavioral health fee schedule or managed care reimbursement requirements are anticipated for an effective date of July 1, 2021, other than COVID-19 actions. NC Medicaid will continue to evaluate how to support rates for walk-in clinic crisis services.
Choose Your Path to Better Health Ad Campaign
NCDHHS has launched a public messaging campaign to encourage Medicaid beneficiaries to enroll in NC Medicaid Managed Care. The “Choose Your Path to Better Health” campaign includes a variety of television and radio spots that are airing in English and Spanish as well as internet and social media messages.
NC Medicaid community partners, advocates, providers and other stakeholders may use these materials to help share the word about NC Medicaid Managed Care and the open enrollment period. This toolkit includes the advertising listed above plus digital images and flyers that can be printed and posted. The toolkit is available on the NC Medicaid website at medicaid.ncdhhs.gov/transformation/managed-care-toolkit.
Update on Johnson & Johnson Vaccine
Out of an abundance of caution, the CDC and FDA announced a recommendation to pause use of the Johnson & Johnson COVID-19 vaccine. Our primary concern is the health and safety of all North Carolinians. Therefore, NCDHHS is following the recommendation of the CDC and FDA and has asked our vaccinating providers to pause the administration of the J&J COVID-19 vaccine until we learn more.
The recommendation follows six reported cases of a rare type of blood clot in individuals after receiving the J&J vaccine. Nationally, more than 6.8 million people have received the J&J shot, 242,762 in North Carolina. None of the six cases reported were in North Carolina.
These adverse events appear to be extremely rare. The vast majority of people who receive the J&J shot will only experience the expected temporary reactions like soreness of arm and feeling achy or tired for a day or two. Mild headaches and flu-like symptoms in the first few days after a vaccination can be expected and are not associated with this more severe concern.
Today's actions are the result of a vaccine safety system that is working. Our safety monitoring systems are highly sensitive, which is how the CDC could identify such a rare number of events. This pause allows them to look further at the data and make sure that providers know how to treat this rare blood clot.
While it is extremely rare that you would have a severe adverse reaction, people who have received the J&J vaccine and develop severe headache, abdominal pain, leg pain or shortness of breath within three weeks of their vaccination should contact their health care provider and mention they’ve received the J&J vaccine.
COVID-19 vaccines remain the most effective way to prevent the spread of COVID-19, hospitalizations, and deaths. Anyone who has an appointment to receive a Pfizer or Moderna COVID-19 vaccine should go to their appointment as planned. Those with an appointment to receive the J&J vaccine will be re-scheduled.
We will continue to provide everyone with timely and accurate information as we learn more. Our goal is that everyone gets a safe vaccine. Everyone 16 and older is now eligible to get vaccinated. The vaccine is free and you don’t need an ID or insurance. You can learn more about vaccines at YourSpotYourShot.nc.gov. To find a local vaccine provider, visit MySpot.nc.gov.
LME-MCO Joint Communication Bulletin #J392
Extension of the Deadline for Meeting Substantial Compliance with the Settlement Agreement Has been Extended Due to COVID-19
The Transitions to Community Living Initiative (TCLI) offers a key to community for eligible adults living with serious mental illnesses, giving them the opportunity to choose where they live, work and receive services.
There have been notable successes achieved over the past year, though we acknowledge that the COVID19 pandemic disrupted the State’s efforts to meet some of the requirements of the Settlement Agreement with the U. S. Department of Justice (DOJ). Most notably, the transition of people out of adult care homes to homes in the community has been challenging during the pandemic.
Accordingly, the State’s work to meet all requirements will continue, as NCDHHS and U. S. DOJ have jointly agreed to extend portions of the 2012 settlement agreement from the amended date for substantial compliance of June 30, 2021, to June 30, 2023. During this difficult year, many worked extremely hard to ensure people who wanted to move out of institutions were able to do so and ensure that others, already in the community, could remain there safely. TCLI’s most notable accomplishments in 2020-2021 include:
- Increasing the number of people living in supported housing by 551.
- Receiving $7 million from the U. S. Housing and Urban Development (HUD) for a key TCLI partner, the North Carolina Housing Finance Agency. The five years of grant funding will provide rental assistance for approximately 188 rental apartments for TCLI participants who are either transitioning from institutions or at risk of institutionalization.
- Implementing an innovative tool that supports informed decision making, ensuring people can make a meaningful decision as to whether a move to community would better their life.
- Initiating a comprehensive quality assurance plan that will integrate TCLI’s work into the state’s transformation of its Medicaid-funded programs, positively impacting the broader Olmstead population.
- Enhancing the understanding of and access to affordable housing for people with disabilities through extensive, statewide training on topics such as fair housing and permanent supportive housing.
- Accelerating job acquisition and job retention along with a strengthened capacity to deliver employment supports to those with disabilities. This includes innovative approaches with the Individual Placement Support (IPS) model of supported employment in partnership with local management entities-managed care organizations (LME-MCOs) and provider networks.
- Implementing significant database modifications to better identify people in Adult Care Homes and connect them to TCLI’s services.
The latest iteration of the agreement offers North Carolinians with serious mental illness the opportunity to receive housing, along with services and supports, in the community of their choice. The agreement flows from a U. S. Supreme Court decision, Olmstead v. L.C. The court’s decision gives people with disabilities in congregate programs the right to receive services and supports in the community. The State’s settlement with U.S. DOJ set in motion the work of NCDHHS’ TCLI, charged with implementing the Olmstead-based requirements of the agreement.
Thousands of people in recovery from mental illness are experiencing the everyday dignity of community life. NCDHHS will continue to advance this transformational, system-wide change, and in so doing, will open the door to community for all.
HCBS Workgroup Update
Below, you will find updates and pertinent HCBS-related information.
- Uplift/Database Update
- IT Updates
- Remove from Database options will appear as follows to streamline reporting:
- No longer contracted with the LME-MCO
- No longer a CAP-DA provider
- Provider has been acquired by another agency
- Provider is no longer in business
- (b)(3) services have been streamlined under the following categories to streamline database report generation:
- (b)(3) SE
- (b)(3) DS
- (b)(3) Residential
- HCBS Validation Update
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4th Quarter Validation Reconciliation Reports were returned to the LME/MCOs in January 2020.
- DHHS Look Behind Status
- Quarter 1: Closed
- Quarter 2: In process (3 out of 8 [7 LME/MCOs & CAP-DA] CLOSED)
- Site Samples were determined based on the eligible sites in our database through 12/31/2019. As Quarterly Validation Reports are submitted, sites are selected from validated sites provided by LME/MCOs and CAP-DA to submit for DHHS Look behind. It is noted that during Quarter 2, 2 entities did not have sites selected for DHHS Look-behind processes.
- Quarter 3: In process (All OPEN)
- Quarter 4: Generating list of sites to submit for LME-MCO/CAP-DAs to initiate validation
- Heightened Scrutiny
- Please refer to the attached letter referencing the status of sites as a result of Heightened Scrutiny reviews.
- Guidance Regarding Multiple Services out of one Site
- Please reference the attached guidance provided to LME-MCOs.
- This information will be added to the HCBS website for reference by the community, as well.
Associated Documents:
